Provider Demographics
NPI:1194084517
Name:LEE, ON-TAT (MD)
Entity type:Individual
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First Name:ON-TAT
Middle Name:
Last Name:LEE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1617 SAINT MARKS PLZ STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6478
Mailing Address - Country:US
Mailing Address - Phone:209-478-1797
Mailing Address - Fax:209-478-1224
Practice Address - Street 1:1617 SAINT MARKS PLZ STE D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6478
Practice Address - Country:US
Practice Address - Phone:209-478-1797
Practice Address - Fax:209-478-1224
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2023-07-14
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Provider Licenses
StateLicense IDTaxonomies
CAA138659207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology